The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

  • Hong, Boohwi (Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital) ;
  • Bang, Seunguk (Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Chung, Woosuk (Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital) ;
  • Yoo, Subin (Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Chung, Jihyun (Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Seoyeong (Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2019.01.14
  • Accepted : 2019.04.15
  • Published : 2019.07.01
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Abstract

Background: Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. Methods: Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). Results: Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB ($33.0{\mu}g$; interquartile range [IQR], $27.0-69.5{\mu}g$) than in the control group ($92.8{\mu}g$; IQR, $40.0-155.0{\mu}g$) (P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs. 55%) were also significantly lower in the ESPB group compared to the control (P = 0.001). Conclusions: Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.

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References

  1. Woodworth GE, Ivie RMJ, Nelson SM, Walker CM, Maniker RB. Perioperative breast analgesia: a qualitative review of anatomy and regional techniques. Reg Anesth Pain Med 2017; 42: 609-31. https://doi.org/10.1097/AAP.0000000000000641
  2. Wildsmith JA. Continuous thoracic epidural block for surgery: gold standard or debased currency? Br J Anaesth 2012; 109: 9-12. https://doi.org/10.1093/bja/aes177
  3. Choe WJ, Kim JY, Yeo HJ, Kim JH, Lee SI, Kim KT, et al. Postpartum spinal subdural hematoma: irrelevant epidural blood patch: a case report. Korean J Anesthesiol 2016; 69: 189-92. https://doi.org/10.4097/kjae.2016.69.2.189
  4. Yeung JH, Gates S, Naidu BV, Wilson MJ, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev 2016; 2: CD009121.
  5. Rawal N. Epidural technique for postoperative pain: gold standard no more? Reg Anesth Pain Med 2012; 37: 310-7. https://doi.org/10.1097/AAP.0b013e31825735c6
  6. Marhofer D, Marhofer P, Kettner SC, Fleischmann E, Prayer D, Schernthaner M, et al. Magnetic resonance imaging analysis of the spread of local anesthetic solution after ultrasound-guided lateral thoracic paravertebral blockade: a volunteer study. Anesthesiology 2013; 118: 1106-12. https://doi.org/10.1097/ALN.0b013e318289465f
  7. Sherwin A, Buggy DJ. Anaesthesia for breast surgery. BJA Educ 2018; 18: 342-8. https://doi.org/10.1016/j.bjae.2018.08.002
  8. Pace MM, Sharma B, Anderson-Dam J, Fleischmann K, Warren L, Stefanovich P. Ultrasound-guided thoracic paravertebral blockade: a retrospective study of the incidence of complications. Anesth Analg 2016; 122: 1186-91. https://doi.org/10.1213/ANE.0000000000001117
  9. Lonnqvist PA, MacKenzie J, Soni AK, Conacher ID. Paravertebral blockade. Failure rate and complications. Anaesthesia 1995; 50: 813-5. https://doi.org/10.1111/j.1365-2044.1995.tb06148.x
  10. Bonvicini D, Giacomazzi A, Pizzirani E. Use of the ultrasound-guided erector spinae plane block in breast surgery. Minerva Anestesiol 2017; 83: 1111-2.
  11. Finneran JJ 4th, Gabriel RA, Khatibi B. Erector spinae plane blocks provide analgesia for breast and axillary surgery: a series of 3 cases. Reg Anesth Pain Med 2018; 43: 101-2. https://doi.org/10.1097/AAP.0000000000000695
  12. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41: 621-7. https://doi.org/10.1097/AAP.0000000000000451
  13. Scimia P, Basso Ricci E, Droghetti A, Fusco P. The ultrasound-guided continuous erector spinae plane block for postoperative analgesia in video-assisted thoracoscopic lobectomy. Reg Anesth Pain Med 2017; 42: 537.
  14. Forero M, Rajarathinam M, Adhikary S, Chin KJ. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: a case series. Scand J Pain 2017; 17: 325-9. https://doi.org/10.1016/j.sjpain.2017.08.013
  15. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia 2017; 72: 452-60. https://doi.org/10.1111/anae.13814
  16. Kline J, Chin KJ. Modified dual-injection lumbar erector spine plane (ESP) block for opioid-free anesthesia in multilevel lumbar laminectomy. Korean J Anesthesiol 2019; 72: 188-90. https://doi.org/10.4097/kja.d.18.00289
  17. Kim E, Kwon W, Oh S, Bang S. The erector sp inae p lane block for postoperative analgesia after percutaneous nephrolithotomy. Chin Med J (Engl) 2018; 131: 1877-8. https://doi.org/10.4103/0366-6999.237408
  18. Bang S. Erector spinae plane block: aninnovation or a delusion? Korean J Anesthesiol 2019; 72: 1-3. https://doi.org/10.4097/kja.d.18.00359
  19. Ramos J, Peng P, Forero M. Long-term continuous erector spinae plane block for palliative pain control in a patient with pleural mesothelioma. Can J Anaesth 2018; 65: 852-3. https://doi.org/10.1007/s12630-018-1097-z
  20. Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Reg Anesth Pain Med 2017; 42: 372-6. https://doi.org/10.1097/AAP.0000000000000581
  21. Masaracchia MM, Herrick MD, Seiffert EA, Sites BD. Nerve blocks under general anesthesia: time to liberalize indications? Reg Anesth Pain Med 2017; 42: 299-301. https://doi.org/10.1097/AAP.0000000000000579
  22. Ho D, Imai K, King G, Stuart EA. MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw 2011; 42: 1-28.
  23. In J, Lee S. Statistical data presentation. Korean J Anesthesiol 2017; 70: 267-76. https://doi.org/10.4097/kjae.2017.70.3.267
  24. Kumar A, Hulsey A, Martinez-Wilson H, Kim J, Gadsden J. The use of liposomal bupivacaine in erector spinae plane block to minimize opioid consumption for breast surgery: a case report. A A Pract 2018; 10: 239-41. https://doi.org/10.1213/XAA.0000000000000674
  25. Tanaka N, Ueshima H, Otake H. Erector spinae plane block for combined lovectomy and radical mastectomys. J Clin Anesth 2018; 45: 27-8. https://doi.org/10.1016/j.jclinane.2017.12.012
  26. Gurkan Y, Aksu C, Kus A, Yorukoglu UH, Kilic CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: a randomized controlled study. J Clin Anesth 2018; 50: 65-8. https://doi.org/10.1016/j.jclinane.2018.06.033
  27. Yoshizaki M, Murata H, Ogami-Takamura K, Hara T. Bilateral erector spinae plane block using a programmed intermittent bolus technique for pain management after Nuss procedure. J Clin Anesth 2019. doi: 10.1016/j.jclinane.2019.03.014.
  28. Tiburzi C, Cerotto V, Gargaglia E, Carli L, Gori F. Pectoral nerve block II with programmed intermittent bolus of local anesthetic and postoperative pain relief in breast surgery. Minerva Anestesiol 2019; 85: 201-2.
  29. Obrink E, Jildenstal P, Oddby E, Jakobsson JG. Postoperative nausea and vomiting: update on predicting the probability and ways to minimize its occurrence, with focus on ambulatory surgery. Int J Surg 2015; 15: 100-6. https://doi.org/10.1016/j.ijsu.2015.01.024
  30. Porreca F, Ossipov MH. Nausea and vomiting side effects with opioid analgesics during treatment of chronic pain: mechanisms, implications, and management options. Pain Med 2009; 10: 654-62. https://doi.org/10.1111/j.1526-4637.2009.00583.x
  31. Ohgoshi Y, Ikeda T, Kurahashi K. Continuous erector spinae plane block provides effective perioperative analgesia for breast reconstruction using tissue expanders: a report of two cases. J Clin Anesth 2018; 44: 1-2. https://doi.org/10.1016/j.jclinane.2017.10.007
  32. Kwon WJ, Bang SU, Sun WY. Erector spinae plane block for effective analgesia after total mastectomy with sentinel or axillary lymph node dissection: a report of three cases. J Korean Med Sci 2018; 33: e291. https://doi.org/10.3346/jkms.2018.33.e291
  33. Kim D, Bang S, Sun WY. Erector spinae plane block with sedation for surgical anesthesia in breast conserving surgery. J Clin Anesth 2019. doi: 10.1016/j.jclinane.2019.03.003.
  34. Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study. Reg Anesth Pain Med 2018; 43: 756-62.
  35. Costache I, de Neumann L, Ramnanan CJ, Goodwin SL, Pawa A , Abdallah FW, et al. The mid-point transverse process to pleura (MTP) block: a new end-point for thoracic paravertebral block. Anaesthesia 2017; 72: 1230-6. https://doi.org/10.1111/anae.14004
  36. Luyet C, Eichenberger U, Greif R, Vogt A, Szucs Farkas Z, Moriggl B. Ultrasound-guided paravertebral puncture and placement of catheters in human cadavers: an imaging study. Br J Anaesth 2009; 102: 534-9. https://doi.org/10.1093/bja/aep015
  37. Damjanovska M, Stopar Pintaric T, Cvetko E, Vlassakov K. The ultrasound-guided retrolaminar block: volume-dependent injectate distribution. J Pain Res 2018; 11: 293-9. https://doi.org/10.2147/JPR.S153660
  38. El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth 2018; 11: 35-44. https://doi.org/10.2147/LRA.S154512
  39. De Cassai A, Bonvicini D, Correale C, Sandei L, Tulgar S, Tonetti T. Erector spinae plane block: a systematic qualitative review. Minerva Anestesiol 2019; 85: 308-19.

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